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Adjuvant Postoperative Therapy for Completely Resected Stage I Lung Cancer

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Difficult Decisions in Thoracic Surgery

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Abstract

Surgical resection is the standard of care for early-stage non-small cell lung cancer (NSCLC). A significant body of evidence from population-based observational studies shows that surgery offers patients the highest cure rate. Nevertheless, following lobectomy or pneumonectomy and mediastinal lymph node staging as standard therapy, only a 67% 5-year survival for stage IA (T1N0) and a 57% 5-year survival for stage IB (T2N0) is expected, with most patients succumbing to metastatic disease. A subset of patients exists with clinical stage I disease and limited cardiopulmonary reserve where a sublobar resection is required and is associated with an increased frequency of local recurrence compared to lobectomy or pneumonectomy. to lobectomy or pneumonectomy. Traditionally, efforts to improve survival and decrease local recurrence following lung resection for NSCLC have consisted of adjuvant chemotherapy and radiation therapy alone or in combination.

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References

  1. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710–1717.

    PubMed  CAS  Google Scholar 

  2. Ginsberg RJ, Rubinstein LV for the Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg 1995;60:615–623.

    Article  PubMed  CAS  Google Scholar 

  3. Patel AN, Santos SS, De Hoyos A, et al. Clinical trials of peripheral stage I (T1N0M0) non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2003;15:421–430.

    Article  PubMed  Google Scholar 

  4. Choi NC, Grillo HC, Gardiello M, et al. Basis for new strategies in postoperative radiotherapy of bronchgenic carcinoma. Int J Radiat Oncol Biol Phys 1980;6:31–35.

    PubMed  CAS  Google Scholar 

  5. Kirsh MM, Sloan H. Mediastinal metastases in bronchgenic carcinoma: influence of postoperative irradiation, cell type, and location. Ann Thorac Surg 1982;33:459–463.

    Article  PubMed  CAS  Google Scholar 

  6. Sawyer TE, Bonner JA, Gould PM, et al. The impact of surgical adjuvant thoracic radiation therapy for patients with non-small cell lung carcinoma with ipsilateral mediastinal lymph node involvement. Cancer 1997;80:1339–1408.

    Article  Google Scholar 

  7. Astudillo J, Conill C. Role of postoperative radiation therapy in stage IIIa non-small cell lung cancer. Ann Thorac Surg 1990;50:618–623.

    Article  PubMed  CAS  Google Scholar 

  8. Effects of postoperative mediastinal radiation on completely resected stage II and stage III squamous cell carcinoma of the lung. The Lung Cancer Study Group. N Engl J Med 1986;315:1377–1381.

    Google Scholar 

  9. Burdett S, Parmar MKB, Stewart LA. Postoperative radiotherapy in non-small cell lung cancer: systematic review and metaanalysis of individual patient data from nine randomized controlled trials. PORT Meta-analysis Trialists Group. Lancet 1998;352:257–263.

    Article  Google Scholar 

  10. Sedrakyan A, Hunt I, Hill J. Multimodality treatment in non-small cell lung cancer surgery. In: Treasure T, Hunt I, Keogh B, Pagano D, eds. The Evidence for Cardiothoracic Surgery. tfm Publishing Ltd.; Harley, Shrewsberry, UK, 2005.

    Google Scholar 

  11. Mayer R, Smolle-Juettner FM, Szolar D, et al. Postoperative radiotherapy in radically resected non-small cell lung cancer. Chest 1997;112:954–959.

    PubMed  CAS  Google Scholar 

  12. Feng QF, Wang M, Wang LJ, et al. A study of postoperative radiotherapy in patients with non-small cell lung cancer: a randomized trial. Int J Radiat Oncol Biol Phys 2000;47:925–929.

    Article  PubMed  CAS  Google Scholar 

  13. Trodella L, Granone P, Valente S, et al. Adjuvant radiotherapy in non-small cell lung cancer with pathological stage I: definitive results of a phase III randomized trial. Radiother Oncol 2002;62:11–19.

    Article  PubMed  Google Scholar 

  14. Landreneau RJ, Sugarbaker DJ, Mack MJ, et al. Wedge resection versus lobectomy for stage I (T1N0M0) non-small cell lung cancer. J Thorac Cardiovasc Surg 1997;113:691–700.

    Article  PubMed  CAS  Google Scholar 

  15. Miller JI, Hatcher CR. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg 1987;44:340–343.

    Article  PubMed  CAS  Google Scholar 

  16. Shennib H, Bogart JA, Herndon J, et al. Thoracoscopic wedge resection and radiotherapy for T1N0 non-small cell lung cancer (NSCLC) in high risk patients: preliminary analysis of a Cancer and Leukemia Group Band E astern Cooperative Oncology Group phase II trial [abstract]. Int J Radiat Oncol Biol Phys 2000;48(suppl 3): abstract 240.

    Google Scholar 

  17. Bogart, JA. Early stage medically inoperable non-small cell lung cancer. Current treatment. Options Oncol 2003;4:81–88.

    Google Scholar 

  18. Nori D, Li X, Pugkhem T. Intraoperative brachytherapy using Gelfoam radioactive plaque implants for resected stage III non-small cell lung cancer with positive margin: a pilot study. J Surg Oncol 1995;60:257–261.

    Article  PubMed  CAS  Google Scholar 

  19. d’Amato TA, Galloway M, Szydlowski G, et al. Intraoperative brachytherapy following thoracoscopic wedge resection of stage I lung cancer. Chest 1998;114:1112–1115.

    PubMed  CAS  Google Scholar 

  20. Fernando HC, Santos RS, Benfield JR, et al. Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2005;129:261–267.

    Article  PubMed  Google Scholar 

  21. American College of Surgeons Oncology Group (ACOSOG) trial Z4032. A randomized phase III study of sublobar resection versus sublobar resection plus brachytherapy in high risk patients with non-small cell lung cancer (NSCLC), 3cm or smaller. Availabe at https://www.acosog.org/studies/organ_site/thoracic/index.jsp. Accessed 8.29.06.

    Google Scholar 

  22. Non-Small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials. BMJ 1995;311:899–909.

    Google Scholar 

  23. Mineo TC, Ambrogi V, Corsaro V, et al. Postoperative adjuvant therapy for stage IB non-small cell lung cancer. Eur J Cardiothorac Surg 2001;20:378–384.

    Article  PubMed  CAS  Google Scholar 

  24. Keller SM, Adak S, Wagner H, et al. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIA non-small cell lung cancer. N Engl J Med 2000;343:1217–1222.

    Article  PubMed  CAS  Google Scholar 

  25. Scagliotti GV, Fossati R, Torri V, et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non small-cell lung cancer. J Natl Cancer Inst 2003;95:1453–1461.

    PubMed  CAS  Google Scholar 

  26. The International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004;350:351–360.

    Article  Google Scholar 

  27. Strauss GM, Herndon J, Maddaus, MA, et al. Randomized clinical trial of adjuvant chemotherapy with paclitaxel and carboplatin following resection in Stage IB non-small cell lung cancer (NSCLC): report of Cancer and Leukemia Group B (CALGB) Protocol 9633. ASCO Annual Meeting Proceedings, New Orleans, Louisiana, USA. J Clin Oncol 2004;22:7019.

    Google Scholar 

  28. Winton TL, Livingston R, Johnson D, et al. A prospective randomised trial of adjuvant vinorelbine (VIN) and cisplatin (CIS) in completely resected stage 1B and II non small cell lung cancer (NSCLC) Intergroup JBR.10. N Engl J Med 2005;352:2289–2297.

    Article  Google Scholar 

  29. Douillard J, Rosell R, Delena M, et al. ANITA: phase III adjuvant vinorelbine (N) and cisplatin (P) versus observation (OBS) in completely resected (stage I-III) non-small-cell lung cancer (NSCLC) patients (pts): final results after 70-month median follow-up. On behalf of the Adjuvant Navelbine International Trialist Association. ASCO Annual Meeting Proceedings, Orlando, Florida, USA. J Clin Oncol 2005;23:7013.

    Article  CAS  Google Scholar 

  30. Kato H, Ichinose Y, Ohta M, et al. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med 2004;350:1713–1721.

    Article  PubMed  CAS  Google Scholar 

  31. Pisters KMW. Adjuvant chemotherapy for non-small cell lung cancer — the smoke clears. N Engl J Med 2005;353:2640–2642.

    Article  Google Scholar 

  32. Kern D, Weisenthal L. Highly specific prediction of antineoplastic drug resistance with an in vitro assay using suprapharacologic drug exposures. J Natl Cancer Inst 1990;82:582–558.

    Article  PubMed  CAS  Google Scholar 

  33. Mehta R, Bomstein R, Yu I-R, et al. Breast cancer survival and in vitro tumor response in the extreme drug resistance assay. Breast Cancer Res Treat 2001;66:225–237.

    Article  PubMed  CAS  Google Scholar 

  34. Loizzi V, Chan JK, Osann K, et al. Survival outcomes in patients with recurrent ovarian cancer who were treated with chemoresistance assay-guided chemotherapy. Am J Obstet Gynecol 2003;189:1301–1307.

    Article  PubMed  Google Scholar 

  35. Holloway R, Mehta R, Finkler N, et al. Association between in vitro platinum resistance in the EDR assay and clinical outcomes for ovarian cancer patients. Gynecol Oncol 2002;87:8–16.

    Article  PubMed  CAS  Google Scholar 

  36. Parker RJ, Fruehauf JP, Mehta R, et al. A prospective blinded study of predictive value of extreme drug resistance assay in patients receiving CPT-11 for recurrent glioma. J Neurooncol 2004;66:365–375.

    Article  PubMed  Google Scholar 

  37. D’amato TA, Landreneau RJ, McKenna RJ, et al. Prevalence of in vitro extreme chemotherapy resistance in resected non-small cell lung cancer. Ann Thorac Surg. 2006;81:440–447.

    Article  PubMed  Google Scholar 

  38. Huang C, Liu D, Masuya D, et al. Clinical application of biological markers for treatments of respectable non-small cell lung cancers. Br J Cancer 2005;92:1231–1239.

    Article  PubMed  CAS  Google Scholar 

  39. Han H, Silverman JF, Santucci TS, et al. Vascular endothelial growth factor expression in stage I non-small cell lung cancer correlates with neoangiogenesis and a poor prognosis. Ann Surg Oncol 2001;8:72–79.

    Article  PubMed  CAS  Google Scholar 

  40. Lu C, Soria J-C, Tang X, et al. Prognostic factors in resected stage I non-small cell lung cancer: a multivariate analysis of s ix molecular markers. J Clin Oncol 2004;22:4575–4583.

    Article  PubMed  Google Scholar 

  41. Siegfried JM, Weissfeld LA, Luketich JD, Weyant RJ, Gubish CT, Landreneau RJ. The clinical significance of hepatocyte growth factor for non-small cell lung cancer. Ann Thorac Surg 1998;66:1915–1918.

    Article  PubMed  CAS  Google Scholar 

  42. Muley T, Dienemann H, Ebert W. CYFRA 21-1 and CEA are independent prognostic factors in 153 operated stage I NSCLC patients. Anticancer Res 2004;24:1953–1956.

    PubMed  CAS  Google Scholar 

  43. Mineo TC, Ambrogi V, Baldi A, et al. Prognostic impact of VEGF, CD31, CD34, and CD 105 expression and tumor vessel invasion after radical surgery for IB-IIA non-small cell lung cancer. J Clin Pathol 2004;57:591–597.

    Article  PubMed  CAS  Google Scholar 

  44. Onn A, Correa AM, Gilcrease M, et al. Synchronous overexpression of epidermal growth factor and HER2-neu protein is a predictor of poor outcome in patients with stage I non-small cell lung cancer. Clin Cancer Res 2004;10:236–243.

    Google Scholar 

  45. Chen G, Gharib TG, Wang H, et al. Protein profiles associated with survival in lung adenocarcinoma. Proc Natl Acad Sci U S A 2003;100:13537–13532.

    Article  PubMed  CAS  Google Scholar 

  46. Rosell R, Fossella F, Milas L. Molecular markers and targeted therapy with novel agents: prospects in the treatment of non-small cell lung cancer. Lung Cancer 2002;38:S43–S49.

    Article  Google Scholar 

  47. Rosell R, Cobo M, Isla D, et al. ERCC1 mRNA-based randomized phase III trial of docetaxel (doc) doublets with cisplatin (cis) or gemcitabine (gem) in stage IV non-small-cell lung cancer (NSCLC) patients (p). ASCO Annual Meeting Proceedings, Orlando, Florida, USA. J Clin Oncol 2005;23:7002.

    Google Scholar 

  48. D’Amico TA, Aloia TA, Moore M-BH, et al. Molecular biologic substaging of stage I lung cancer according to gender and histology. Ann Thorac Surg 2000;69:882–886.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center Presbyterian — Shadyside, Pittsburgh, PA, USA

    Thomas A. D’Amato MD, PhD

  2. Heart and Lung Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Rodney J. Landreneau MD

Authors
  1. Thomas A. D’Amato MD, PhD
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  2. Rodney J. Landreneau MD
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Editors and Affiliations

  1. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Mark K. Ferguson MD (Professor and Head) (Professor and Head)

  2. Thoracic Surgery Service, The University of Chicago Hospitals, Chicago, IL, USA

    Mark K. Ferguson MD (Professor and Head) (Professor and Head)

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© 2007 Springer-Verlag London Limited

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D’Amato, T.A., Landreneau, R.J. (2007). Adjuvant Postoperative Therapy for Completely Resected Stage I Lung Cancer. In: Ferguson, M.K. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-474-8_11

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  • DOI: https://doi.org/10.1007/978-1-84628-474-8_11

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-384-0

  • Online ISBN: 978-1-84628-474-8

  • eBook Packages: MedicineMedicine (R0)

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